Improving Health and Health Care: An Agenda for Reform

The debate over, and eventual enactment of, the Affordable Care Act (ACA) brought to the surface of American politics a long-standing divide over the proper orientation of health care policy. On one side are those who tend to promote more federal control and government regulation over insurance markets and the organizations delivering services to patients. On the other side are those who are more inclined to support consumer incentives and market mechanisms to improve the value and quality of patient care. Of course, there is overlap in the kinds of policies advanced by the two sides in this debate, but the underlying philosophical disagreement is deep and makes reaching broad-based consensus difficult.

At the moment, the proponents of the ACA believe the new law is working, and initiatives are being readied to build upon what was enacted in 2010 by further bolstering the federal government’s power to control costs through additional regulation.

We are among those who opposed the ACA because of its heavy emphasis on federal control. But we also believe that unless a credible and practical alternative reform plan is presented to the public, and supported by policymakers, the long-term trend toward ever-increasing governmental control will continue unabated in the years ahead.

The plan we present is not confined to replacing the ACA. We propose major reforms to the tax treatment of employer-sponsored health care, Medicaid, Medicare, Health Savings Accounts, and other areas of existing policy. The cumulative effect of this comprehensive plan would be to decisively reorient health care policy away from bureaucratic regulation and toward the preferences of patients and consumers.

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